Imperial College London


Faculty of MedicineSchool of Public Health

Chair in Global Environmental Health



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BibTex format

author = {McCoy, DC and Peet, ED and Ezzati, M and Danaei, G and Black, MM and Sudfeld, CR and Fawzi, W and Fink, G},
doi = {10.1371/journal.pmed.1002034},
journal = {PLOS Medicine},
title = {Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling},
url = {},
volume = {13},
year = {2016}

RIS format (EndNote, RefMan)

AB - BACKGROUND: The development of cognitive and socioemotional skills early in life influences later health and well-being. Existing estimates of unmet developmental potential in low- and middle-income countries (LMICs) are based on either measures of physical growth or proxy measures such as poverty. In this paper we aim to directly estimate the number of children in LMICs who would be reported by their caregivers to show low cognitive and/or socioemotional development. METHODS AND FINDINGS: The present paper uses Early Childhood Development Index (ECDI) data collected between 2005 and 2015 from 99,222 3- and 4-y-old children living in 35 LMICs as part of the Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS) programs. First, we estimate the prevalence of low cognitive and/or socioemotional ECDI scores within our MICS/DHS sample. Next, we test a series of ordinary least squares regression models predicting low ECDI scores across our MICS/DHS sample countries based on country-level data from the Human Development Index (HDI) and the Nutrition Impact Model Study. We use cross-validation to select the model with the best predictive validity. We then apply this model to all LMICs to generate country-level estimates of the prevalence of low ECDI scores globally, as well as confidence intervals around these estimates. In the pooled MICS and DHS sample, 14.6% of children had low ECDI scores in the cognitive domain, 26.2% had low socioemotional scores, and 36.8% performed poorly in either or both domains. Country-level prevalence of low cognitive and/or socioemotional scores on the ECDI was best represented by a model using the HDI as a predictor. Applying this model to all LMICs, we estimate that 80.8 million children ages 3 and 4 y (95% CI 48.1 million, 113.6 million) in LMICs experienced low cognitive and/or socioemotional development in 2010, with the largest number of affected children in sub-Saharan Africa (29.4.1 million; 43.8% of childre
AU - McCoy,DC
AU - Peet,ED
AU - Ezzati,M
AU - Danaei,G
AU - Black,MM
AU - Sudfeld,CR
AU - Fawzi,W
AU - Fink,G
DO - 10.1371/journal.pmed.1002034
PY - 2016///
SN - 1549-1277
TI - Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling
T2 - PLOS Medicine
UR -
UR -
VL - 13
ER -